A 69 year old man comes to your clinic with presenting complain of weakness in his left arm. His vitals are:
Temp: 98.6 F
BP: 160/100 mmHg
HR: 80/min
RR: 20/min
Q 1. List the points you would like to ask in clinical history?
Answer: In this ask ask about:
- onset of the weakness.
- Course and intensity since the onset. ( either getting better, worse or no change)
- Associated symptoms ( weakness else where in the body, difficulty swallowing etc)
- Previous episode of similar weakness
- Review of symptoms should include any H/O chest pain, headache, nausea. vomiting, palpitations, blackouts, syncope, dizziness.
- Past history of any medical illness (Ask if already diagnosed with High BP)
- H/o any allergies and surgeries in the past.
- H/o smoking and alcohol intake.
- What medicines he is taking (prescription and over the counter)
Q 2. Write down the list of examination you would perform on this patient ?
Answer: Look and examine the:
- Pupils
- Visual fields.
- Auscultate the lungs
- Auscultate the heart and listen for any murmurs or irregular heart beat.
- Check the mental status of the patient and see if he is oriented .
- Check the cranial nerves ( specifically the 7th CN and look for any facial weakness)
- Deep tendon reflexes in all four limbs and compare the weak arm with the normal side.
- Sensory system in all four limbs.
- Ask the patient to walk and check the gait.
Q 3. With a patient presenting with left arm weakness what would you suspect?
Answer: Left arm weakness can have many causes. It may include:
- Stroke a common reason in a older patient with high BP as in this case.
- Transient ischemic attack
- Lesion to the spinal cord or peripheral nerves
- Musculoskeletal problems.
- Decreased blood flow to the affected arm
Q 4. What diagnostic tests would you order in this patient?
Answer:
- Head CT scan (non contrast)
- CBC
- BUN and creatinine
- Blood Glucose
- ECG
- Chest X ray
He heals and solve most of the problems & sickness which are failed to be healed by other doctors/healers. He solve bad luck, pregnancy problems, lost lover, sexual weakness, early ejaculation, witch-crafts, broken marriage, poverty, debts trouble, divorce, court cases, domestic problems, gambling losses, Lost jobs, promotions at work, Do you need penis enlargement? Do you want to be Rich? Do you need many children? Are you tired of jealousy people, Evil dreams, all long illnesses, blood pressure, HIV & aids, skin infections? etc. He use strong herbs & magic spells as well as powerful ancestors. Get healed today by this greatest miracle doctor who has healed many people through his experienced ancestors. Join the rest of the world to cerebrate his miracle healings. he can even read and tell you your problems before you say anything to him. He can connect you to talk to the spirit of a deceased of your family member or friend. he can also tell you your future through reading palm, play card, a mirror/water. He uses many ways of healing just to make sure that he certify his clients all over the world. he is the only traditional healer who does fully corresponds with all religious beliefs. contact him on his email address at babaka.wolf@gmail.com or Facebook at priest.babaka
ReplyDeleteI am happy to recommend dr Godday for his great help, i suffered for years seeking for the cure of herpes virus. i came across a testimony about his herbal medicine and i contacted him and he sent me a herbal remedy. I am happy to say that i am cured and negative of herpes virus type2. A doctor with many health experience and has many herbal medicine for most of the diseases you believed that had no cures. He has herbal remedies for Cancer, Herpes virus, Lime, Hepatitis and Kidney disease Contact him on his Email: goddayspiritualhome@gmail.com or Whats app only +1{919}4956404
ReplyDeleteI started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their website at www.ultimatelifeclinic.com I can breath much better and It feels comfortable!
ReplyDelete